Colonic stents for malignant bowel obstruction: current status and future prospects

ABSTRACT

Introduction: Although more than two decades are already passed from the first description of this technique, the debate remains open on the role of self-expanding metal stents (SEMS) placement in the management of malignant bowel obstruction (MBO). According to most recent data, SEMS placement is considered a safe and effective alternative treatment as a bridge to surgery(BTS). In addition, stent placement should be considered as primary option for palliative treatment of obstructing cancer.

Areas covered: Current status, indication, technique, oncological outcomes, advantages, and risks of SEMS placement in MBO were reviewed.

Expert commentary: The placement of colonic SEMS for palliation and for BTS in patients with MBO has been increasingly reported and it seems to have several advantages over emergency surgery. Substantial concerns of tumor seeding following SEMS placement, especially in case of perforation, have been raised in numerous studies. Actually, no significant differences are reported in oncologic long-term survival between patients undergoing stent placement as a BTS and those undergoing emergency surgery. Considering all the mentioned factors, indication for colorectal stenting should be evaluated only in highly specialized centers, in the context of multidisciplinary approach where risks and benefits of stenting are carefully weighed, especially in the BTS setting.

KEYWORDS:

• Colorectal cancer
• bowel obstruction
• emergency surgery
• endoscopy
• bridge to surgery
• palliation
• self-expandable metal stent
• colonoscopy

Article Highlights

• Self-expanding metal stents (SEMS) placement is considered a safe and effective alternative treatment as a bridge to surgery (BTS).

• A short interval from SEMS placement to surgery is an independent predictor of post-operative complications (POCs) in patients undergoing elective surgery in a BTS setting.

• Stent placement should be considered as primary option for palliative treatment of obstructing cancer.

• Uncovered stents are more indicated in the management of malignant bowel obstruction (MBO) and associated with fewer complications.

• The endoscopic expertise seems to play a crucial role in influencing the complication rate.

Declaration of interest

A Repici has acted as a consultant for Boston Scientific. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.